目的 通过对自身免疫性肝炎(AIH)患者临床数据进行分析,研究肝纤维化无创诊断模型FIB-4指数对AIH肝纤维化的诊断价值.方法 回顾性分析2010年1月-2015年12月于首都医科大学附属北京地坛医院住院且经肝活组织检查确诊的71例AIH患者的临床资料,包括年龄、ALT、AST、PLT,计算FIB-4指数,分析FIB-4指数与肝纤维化病理分期的相关性,以及FIB-4指数诊断AIH肝纤维化的特异度和敏感度.计量资料组间比较采用Kruskal-WallisH秩和检验.相关性分析采用Spearman秩相关分析.绘制受试者工作特征曲线,分析曲线下面积(AUC).结果 FIB-4指数在不同肝纤维化分期间差异有统计学意义(r=10.134,P=0.038),年龄、ALT、AST、PLT在不同肝纤维化分期差异均无统计学意义(P值均＞0.05).FIB-4指数与肝纤维化程度呈正相关(rs=0.338,P=0.004),而PLT与肝纤维化程度呈负相关(rs=-0.305,P=0.010).FIB-4指数诊断AIH肝纤维化S≥1、S≥2、S≥3的AUC分别为0.603、0.698、0.704(P值分别为0.408、0.004、0.049),FIB-4指数对于轻度肝纤维化(≥S1的肝纤维化)诊断的特异度和敏感度差,而对于肝纤维化≥S2的敏感度为77.4％,肝纤维化≥S3的敏感度为88.9％.结论 当患者无肝纤维化或肝纤维化程度较轻时,FIB-4指数作为肝纤维化评判指标诊断价值不显著,而对于显著肝纤维化(S≥2)及严重肝纤维化(S≥3)均有诊断价值,其中对于严重肝纤维化的诊断效能更高.%Objective To investigate the value of the noninvasive diagnostic model of liver fibrosis fibrosis-4 (FIB-4) index in the diagnosis of liver fibrosis in autoimmune hepatitis (AIH) through an analysis of the clinical data of AIH patients.Methods A retrospective analysis was performed for the clinical data of 71 AIH patients who were hospitalized in Beijing Ditan Hospital,Capital Medical University from January 2010 to December 2015 and underwent liver biopsy,including age,alanine aminotransferase (ALT),aspartate aminotransferase (AST),and platelet count (PLT).FIB-4 index was calculated and its correlation with pathological staging of liver fibrosis was analyzed,as well as the specificity and sensitivity of FIB-4 index in the diagnosis of liver fibrosis in AIH patients.The Kruskal-Wallis H test was used for comparison of continuous data between groups.Spearman correlation analysis was also performed.The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was analyzed.Results There was a significant difference in FIB-4 index between patients with different stages of liver fibrosis (x2 =10.134,P =0.038),but there were no significant differences in age,ALT,AST,and PLT between these patients (all P ＞ 0.05).FIB-4 index was positively correlated with fibrosis degree and increased with the increase in fibrosis degree (rs--0.338,P =0.004),while PLT was negatively correlated with fibrosis degree (rs =-0.305,P =0.010).In the diagnosis of S ≥ 1,S ≥2,and S ≥3 liver fibrosis in AIH,FIB-4 index had AUCs of 0.603 (P =0.408),0.698 (P =0.004),and 0.704 (P =0.049),respectively.FIB-4 had relatively low sensitivity and specificity for the diagnosis of S ≥ 1 liver cirrhosis,but had a relatively high sensitivy for the diagnosis of S≥2 liver cirrhosis (77.4％) and S≥3 liver fibrosis (88.9％).Conclusion FIB-4 index does not have a significant value in evaluating liver fibrosis in patients without liver fibrosis or with mild liver fibrosis,while it has a high value in the diagnosis of marked (S ≥ 2) and severe (S ≥ 3) liver fibrosis.It has better results in the diagnosis of severe liver fibrosis than marked liver fibrosis.
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